Spontaneous reperfusion before intervention improves immediate but not long-term prognosis in diabetic patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease

Abstrakt

Background: The presence of normal thrombolysis in myocardial infarction (TIMI) flow grade 3 before percutaneous coronary intervention (PCI) is associated with better outcomes. The aim of this study was to evaluate the association of spontaneous reperfusion (SR) before PCI and its effect on the immediate and long-term outcomes in diabetic patients.

Methods: A total of 1,850 patients with myocardial infarction and multivessel coronary artery disease undergoing primary PCI were enrolled and divided into 4 groups: (1) patients with diabetes mellitus (DM) and initial TIMI < 3 flow (n = 491), (2) patients with DM and initial TIMI 3 flow (n = 48), (3) patients without DM and with initial TIMI < 3 flow (n = 1,196), (4) patients without DM and with initial TIMI 3 fl ow (n = 115).

Results: SR before PCI was similar in diabetic and non-diabetic patients (8.9% vs. 8.8%, p = 0.8). DM was not an independent predictor of either pre-procedural or post-procedural TIMI 3 fl ow. In-hospital mortality rate was the highest in group 1 and the lowest in group 4 (p < 0.0001). Death rates of patients from groups 2 and 3 were similar (approximately 8.3% each, p = 0.9). Non-diabetic patients had a higher 1-year survival rate than diabetic patients, irrespective of their initial TIMI flow.

Conclusions: SR is associated with a similar post-PCI improvement in epicardial blood flow both in diabetic and non-diabetic patients. SR improves in-hospital survival of diabetic patients, which is similar to the survival of non-diabetic patients without SR. The benefi cial effect of SR in diabetic patients disappears during 1-year follow-up.